Transcript
Executive Functions
Improving Executive Functions: Strategies to Change the Brain and Change Behavior Presented by
George McCloskey, Ph.D. Philadelphia College of Osteopathic Medicine
[email protected] or
[email protected] 1
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Michael Posner
– Naïve: First exposure to the task;; responses required immediately. – Practiced: Time given to rehearse responses to the task;; responses delivered after rehearsal period. 3
McCloskey – Executive Functions
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Executive Functions
System 1 – Fast, effortless, automatic
System 2 – Slow, effortful, non-automatic
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Things that are Taught to Automaticity in Early Elementary School § Basic math facts and multiplication
tables § The alphabet and sight word recognition
Key Concept Executive functions are used to c ue, direct, coordinate and integrate all the processes, skills, abilities, and knowledge bases used when reading writing or doing math. 8
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Executive Functions
An Integrative Model Specifying Processes, Abilities, Knowledge Bases, Skills, Memory and Achievement in Reading indicate Executive Function processing at work Retrieval from Long Term Storage Working Memory Initial Registration (Immediate Memory)
General & Specific Knowledge Lexicons
Language
Semantic Lexicon Word & Phrase Knowledge
Reasoning
Visuospatial
Comprehending Words and Text Decoding Unfamiliar and/or Nonsense Words
Speed + Prosody = Reading Rate aka “Fluency”
Reading Familiar (Sight) Words
Phonological Processing
Interventions f or Executive Functions Difficulties Related t o Reading
Many executive functions difficulties related to reading are the result of a lack of adequate maturation of the neural networks involved in the use of these executive functions for reading.
Oral Motor Functioning
Processing Cop yrig ht © 2007Orthographic Georg e M cCloskey, Ph.D.
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Interventions f or Executive Functions Difficulties Related t o Reading
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Things that are Taught to Automaticity in Early Elementary School
The most effective form of intervention for maturational difficulties with executive functions cues is increased practice of the complete act of reading, i.e., applying the integration of all processes, skills, abilities and lexicons while reading connected text while receiving feedback from an external source.
§ Basic math facts and multiplication
tables § The alphabet and sight word recognition § Graphomotor functioning for quick handwriting of letters and words
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Executive Functions
An Integrative Model Specifying Processes, Abilities, Knowledge Bases, Skills, Memory and Achievement in Writing indicate Executive Function processing at work Initial Registration (Immediate Memory) Working Memory Retrieval from Long Term Storage
General & Specific Knowledge Lexicons
Language
Semantic Lexicon Word & Phrase Knowledge
Idea Generation
Reasoning
Visuospatial
Text Editing & Revising
Text Generation
Text Transcription & Spelling
Visuospatial Processing Cop yrig h t ©Processing 2007 Georg e Orthographic McClosk ey, Ph .D.
Text Production Automaticity
– Novel: Second exposure to the task, but responses required immediately to a set of all new items.
GraphoMotor Processing Phonological Processing 13
– Naïve: First exposure to the task;; responses required immediately;; high demand for executive functions (EFs) – Practiced: Time given to rehearse responses to the task;; minimal demand for EFs – Novel: Second exposure to the task, but responses required immediately to a set of all new items;; moderate demand for Efs – Source: Posner, M.I. & Raichle, M.E. (1994). Images of Mind.
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Behavior Observation and Inferences about Brain Function
Key Concept Assessment of the Use or Disuse of Executive Functions Hinges on Careful Observation of Behavior.
What’s the difference between a Similarities Scaled Score of 12 (75th percentile) … …and a Similarities Scaled Score of 12 (75th percentile)?
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Key Concept
Key Concept Task Performance is directed by Executive Functions or an Executive Functions substitute. The neural networks used to perform a task depend on perceptions about how the task should be done. 19
McCloskey – Executive Functions
Most of what a teacher, therapist, or work supervisor says to student, client, or worker is intended to activate specific neural networks within that person’s brain. 20
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Key Concept
The W isdom of Kurt Lewin
The more specific the language used by a teacher, therapist or supervisor the more likely it is that the student, client or worker will be activating the brain networks needed for effective performance.
“There is nothing more practical than a good theory.” Known for h is field theory of behavior that posits that human b ehavior is a function of an individual’s psychological environment.
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What Are Executive Functions? “Despite the frequency with which it is mentioned in the neuropsychological literature, the concept of executive f unctions is one that still awaits a f ormal definition. Research efforts aimed at exploring the different aspects of this c onstruct have often yielded contradictory evidence, r esulting in a lack of clarity and even c ontroversy r egarding the true nature of executive abilities.” Jurado & Rosselli, 2007, page 213.
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EF as t he Conductor of t he Brain’s O rchestra or CEO of t he brain ( i.e., EF as “g”) EF
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Executive Functions
Thoughts
Key Concept
EFs
Executive Functions:
Perceptions
§ § § §
Emotions
§
Actions
Executive Functions Are Not a Unitary Trait
Appropriate Metaphors for Executive Functions: § The conductor and section leaders of the mind’s Orchestra § The management structure of a multinational mind corporation § The coaching staff of team mind
Directive capacities o f the mind Multiple in n ature, n ot a single capacity Part o f n eural circuits that a re routed through the frontal lobes Cue the u se o f o ther mental capacities Direct a nd control p erceptions, thoughts, a ctions, a nd to some degree e motions
The Management Structure within a Holarchical EF Model of EF Trans-Self Integration EF
EF
SelfRealization ef/es
ef/es ef/es
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SelfDetermination ef/es
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Self-Regulation
Self-Activation
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ef/es
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Self-Generation
EF
Activation
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Domains of Functioning Directed by Executive Functions
E m o t i o n
Action
Cognition Perception
Action Executive control of modes of output including behavior in the external world and storage and retrieval of internal representations Cognition Executive control of thoughts and thought processing
The Management Structure within a Holarchical Model of EF EF Trans-Self Integration
SelfRealization ef/es
ef/es
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Executive Functions
ES
Self-Activation
ef/es ef/es
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Activation
Management Structure within a Holarchical Model of EF EF Trans-Self Integration
EF
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Self-Generation
EF
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Self-Realization
Self-Awareness Other-Awareness Self-Analysis ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
Self-Determination
e ef/es f/ Self-Regulation e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es s Monitor ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Perceive ef/es Focus Correct
Goal setting Long-range Planning & Foresight
ef/es
Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate
ES Activation
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ef/es
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EF Executive Skills
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SelfDetermination
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Self-Generation
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Self-Regulation
EF ES EF ES
ef/es ef/es
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Emotion Executive control of moods, feelings, and the processing of emotions
Executive Capacities
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Perception Executive control of modes of perceptual input including external sensory stimuli (visual, auditory, kinesthetic) and internal (representational) stimuli
Management Structure within a Holarchical Model of EF EF
EF
EF
Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize
Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve
Self-Activation
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Self Regulation Executive Functions
Key Concept
Executive Functions involve the part of the executive network that that is used to become aware of the need for the use of executive skills and other mental capacities and used to cue and direct the use of the needed executive skills.
It is important to distinguish between Executive Functions and Executive Skills.
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Self Regulation Executive Skills
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EF Tiers within the Holarchical Model of Executive Functions Trans-Self Integration EF
Executive Skills are responsible for cueing the specific areas of the brain needed to perform specific tasks (e.g., attending, inhibiting, modulating, planning, organizing, associating).
Self-Generation EF
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EF
ef ef
EF
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Self-Realization
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Self-Determination
Self-Awareness Other-Awareness Self-Analysis
e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es f/ ef/es e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es s ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
Goal setting Long-range Planning & Foresight
Self-Regulation Perceive Focus Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate
Monitor Correct Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize
Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve
Self-Activation 35
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Activation
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Self Regulation
33 Self-Regulation EFs
§ A set of control capacities that cue and direct functioning across the domains of perception, emotion, cognition, and action § The current model posits 33 self- regulation executive functions ef/es
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ef/es ef/es ef/es
ef/es ef/es ef/es
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ef/es ef/es
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ef/es 37
Perceive Focus Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate
§ § § § § § § § § § §
Balance Monitor Correct Gauge Anticipate Est Time Analyze Generate Associate Plan Organize
§ § § § § § § § § § §
Prioritize Compare/Eval Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve
Self Regulation Executive Function “Clusters”
Key Concept
ENGAGEMENT
Self-regulation Executive Functions can be organized into 7 basic c lusters.
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§ § § § § § § § § § §
ATTENTION Perceive Focus Sustain
MEMORY Hold Manipulate Store Retrieve
Energize Initiate Inhibit Stop Pause Flexible Shift
OPTIMIZATION EFFICIENCY Sense Time Monitor Pace Modulate Sequence Balance Execute Correct
INQUIRY Anticipate Gauge Analyze Estimate Time Compare
SOLUTION Generate Associate Prioritize Plan Organize Decide 40
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Key Concept Tools of the Mind (Bodrova & Leong) is an effective preschool /kindergarten curriculum that helps young children improve self-regulation executive functions.
Tools of t he Mind Elena Bodrova & Deborah Leong
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Bronson & Merryman discuss t heir observations of the Tools of t he Mind curriculum in Chapter 8 Can Self- Control Be Taught? 43
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EF Tiers within the Holarchical Model of Executive Functions EF Trans-Self Integration EF
EF
ef ef ef
Self-Generation
EF
ef ef
Self-Realization
Self-Awareness Other-Awareness Self-Analysis ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
e ef/es f / ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es e ef/essef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
Activation
Self-Determination Goal setting Long-range Planning & Foresight
Self-Regulation
Perceive Focus Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate
Monitor Correct Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize
Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve
Self-Activation
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Self Activation
Holarchy vs Hierarchy Hierarchy
Initiation and “ramping up” of basic executive functions related to an awakened state of mind and to overcoming sleep inertia.
Self-Activation
Holarchy 45
Holoarchy vs Hierarchy
Key Concept
§ Within a hierarchy, the next s tage of development does not begin until the stage preceding it is complete. § Within a holarchy, additional stages of development c an begin before earlier stages are c ompleted;; earlier s tages c an continue to develop after later s tages begin;; multiple stages may be developing at the same time;; later s tages may be better developed than earlier s tages.
Executive Functions cue and direct in different ways at different levels.
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EF Tiers within the Holarchical Model of Executive EF Functions Trans-Self Integration EF
EF
ef
ef
Self-Generation
EF
ef
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ef
Self-Realization
Self-Determination
Self-Awareness Other-Awareness Self-Analysis ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
e ef/es f/ Self-Regulation e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es s Monitor ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Perceive ef/es Focus Correct
Goal setting Long-range Planning & Foresight
ef/es
Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate
Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize
Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve
Self-Activation
Activation
ef
EF
ef ef
Self-Generation
EF
ef
§ Directs cognitive processes that engage in awareness of self and others, reflection about self and others and self-analysis. § Cues cognitive processes to access accumulated information about self and apply it in specific situations.
EF 50
EF Tiers within the Holarchical Model of Executive Functions EF Trans-Self Integration EF
Self Realization (of self & others)
ef
Self-Realization Self-Awareness Other-Awareness Self-Analysis
Self-Determination
e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es f/ ef/es Self-Regulation e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es s Perceive Monitor ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Focus Correct ef/es Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate
Goal setting Long-range Planning & Foresight
Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize
Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve
Self Determination
EF
§ Foresight/Long-Term Planning and Goal Generation § Directs the use of cognitive processes to construct visions of the future and plans for action over longer periods of time. Attempts to to align daily self-regulation with long-term goals.
Self-Activation Activation
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Chapter 21 Motivational Interviewing with Adolescents and Young Adults John S. Baer and Peggy L. Peterson
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EF Tiers within the Holarchical Model of Executive EF Functions Trans-Self Integration EF
ef
EF
ef ef
Self-Generation
EF
ef
ef
Self-Realization
Self-Awareness Other-Awareness Self-Analysis ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
Self-Determination
e ef/es f/ Self-Regulation e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es s Monitor ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Perceive ef/es Focus Correct
Goal setting Long-range Planning & Foresight
ef/es
Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate
Activation
Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize
Self-Activation
McCloskey – Executive Functions
Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve
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Self Generation
EF
§ Directs the posing of speculative questions related to the meaning and purpose of life and/or the ultimate source(s) of r eality and physical existence, mind-body r elationships, spirit, and soul;; contemplates existence beyond the physical plane. § Directs the generation of a philosophy of life used to guide self-awareness, s elf-realization and the other levels of executive function processes;; s erves as a basis for an ultimate source of intentional behavior direction. 56
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EF Tiers within the Holarchical Model of Executive EF Functions Trans-Self Integration EF
ef
EF
ef ef
Self-Generation
EF
ef
ef
Self-Realization
Self-Awareness Other-Awareness Self-Analysis ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es
Self-Determination
e ef/es f/ Self-Regulation e ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es s Monitor ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es ef/es Perceive ef/es Focus Correct
Goal setting Long-range Planning & Foresight
ef/es
Sustain Energize Initiate Inhibit Stop Interrupt Flexible Shift Modulate
Activation
Balance Gauge Anticipate Estimate Time Analyze Generate Associate Organize Prioritize
Plan Evaluate/Compare Decide Sense Time Pace Sequence Execute Hold Manipulate Store Retrieve
Trans-Self Integration
EF
§ Directs the engagement of mental processes that enable r ealization and experiencing of a trans-self s tate of ultimate or unity c onsciousness. § In most s piritual traditions, this s tate is considered the highest achievement of human c onsciousness and therefore v ery different from the maladaptive states characteristic of c linical diagnoses of dissociative s tates.
Self-Activation 58
Arenas of Involvement
Key Concept Effective use of Executive Functions can vary by Arena of Involvement as well as by Domain of Functioning.
Intrapersonal Control of Self in Relation to Self
Interpersonal Control of Self in Relation to Others
Environment Control of Self in Relation to Surroundings
Symbol System Control of Self in Relation to Academics (Reading, Writing, Math)
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Key Concept
EF Development -
Not!
Executive Functions are developing from birth;; maturational delays c an cause difficulties.
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Executive Function Development
EF Development -
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Some EF-based clinical syndromes, such as ADHD, demonstrate clear patterns of delayed developmental progression. Barkley (1998) estimates developmental delays of about 30% associated with various EF processes such as Inhibit, Manipulate, Shift, Sustain, Time, Monitor, Correct. 64
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EF Development does not progress by continuous equal intervals
Developmental Progression with a 30% Delay 100 90 80
E F
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A G E
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E Q
20
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40 30
10 0
6 8 10 15 21 30 39 60 90 Chronological Age
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EF Development does not progress by continuous equal intervals
DAILY PROGRESS BY CLASS ENGAGEMENT Math Science Social Studies English Reading Math Facts
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WEEK 1 4-‐Feb 5-‐Feb 6-‐Feb 7-‐Feb 8-‐Feb 3 3 3 3 2 3 3 3 3 3 3 3 2 3 2 3 3 0 3 3 3 3 0 0 3 3 3
ENGAGEMENT Math Science Social Studies English Reading Math Facts
WEEK 5 4-‐Mar 5-‐Mar 6-‐Mar 7-‐Mar 8-‐Mar 3 3 3 1 3 0 2 1 3 3 3 2 1 3 2 2 3 1 3 3 3 2 3 0 3 0 3 3
ENGAGEMENT Math Science Social Studies English Reading Math Facts
WEEK 9 1-‐Apr 2-‐Apr 3-‐Apr 4-‐Apr 5-‐Apr 2 2 3 3 3 3 3 3 3 3 3
ENGAGEMENT Math Science Social Studies English Reading Math Facts
WEEK 2 11-‐Feb 12-‐Feb 13-‐Feb 14-‐Feb 15-‐Feb 0 2 0 0 1 0 2 0 0 0 0 3 2 3 3 3 3 0 3 0 0 3 3 3 0 0 3 0 3 0
WEEK 6 11-‐Mar 12-‐Mar 13-‐Mar 14-‐Mar 15-‐Mar 3 2 1 3 0 3 3 3 3 3 3 3 3 3
WEEK 10 15-‐Apr 16-‐Apr 17-‐Apr 18-‐Apr 19-‐Apr 3 0 0 3 3 0 0 0 3 3 1 3 3 3 2 0 1 3 3 3 2 3 3 3 0 3 3 3
WEEK 13 6-‐May 7-‐May 8-‐May 9-‐May 10-‐May 0 1 0 1 2 2 3 2 3 2 3 3 3 0 3 3 3 3 3 3 3 3 3 3
WEEK 3 19-‐Feb 20-‐Feb 21-‐Feb 22-‐Feb 23-‐Feb 1 0 3 0 3 3 3 2 0 0 3 3 3 3 3
WEEK 4 25-‐Feb 26-‐Feb 27-‐Feb 28-‐Feb 1-‐Mar 0 3 2 2 3 0 2 2 0 2 3 1 3 3 3 3 3 3 3 3 3 0 3 3 3
WEEEK 7 18-‐Mar 19-‐Mar 20-‐Mar 21-‐Mar 22-‐Mar 0 0 1 0 3 0 0 0 0 3 3 3 3 3 3 3 3 0 3 3 3 3 3 3 3 3 3 3 0
WEEK 11 22-‐Apr 23-‐Apr 24-‐Apr 25-‐Apr 26-‐Apr 0 0 3 3 3 3 0 3 1 3 1
13-‐May 2 0 0 2
14-‐May 0 1 3 3
WEEK 14 15-‐May
WEEK 8 25-‐Mar 26-‐Mar 27-‐Mar 28-‐Mar 29-‐Mar 1 0 1 3 3 3 3 3 3 3 3 3
WEEK 12 29-‐Apr 30-‐Apr 1-‐May 2-‐May 3-‐May 3 0 0 3 3 2 2 1 2 2 0 3 0 3 3 3 3 3 3 3 3 2 3 3
16-‐May 1 1 0 2 2
17-‐May 1 0 0 0 3 68 3
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END OF YEAR SUMMARY ALL CLASSES ENGAGEMENT Rated 3 , 2 , or 1 Rated 0 ATTENTION Rated 3 , 2 , or 1 Rated 0 WORK COMPLETION Rated 3 , 2 , or 1 Rated 0
Key Concept
% 78% 22% % 78% 22% % 70% 30%
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Intervention efforts r equire a therapeutic perspective that emphasizes a G rowth Mindset over a Fixed Mindset and a patient belief in the idea that EF difficulties “won’t last forever;; but probably longer than y ou would like.”
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Zeno’s Paradox
Langer: Reverse Zeno’s Paradox
§ An arrow is released at a target. § At any point in the arrows flight toward the target, the distance between the arrow and the target can be halved. § Mathematically, the distance between the arrow and the target therefore can be halved infinitely such that the arrow never really reaches the target.
§ Every intervention starts with an infinitely small step toward positive growth. § Each successive s tep doubles in impact. § Response to intervention therefore may not be noticeable until long after the intervention has started. § Once positive change is detectable, it seems to increase dramatically in a short period of time.
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Reverse Zeno’s Paradox: Jake’s Case § Neurodevelopmental complications due to Polygyria § At age 7 Jake was self-regulating at a 5 month level. § With intensive intervention, a t age 1 4 Jake was self-regulating at a 5 ½ year level. § Nearly all of Jake’s improvements in self- regulation o ccurred between a ges 12 ½ and 1 4 § 7 years of intervention with gains realized only in the last 18 months of that time period. 75
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Key Concept Virtually all individuals who struggle with psychological disorders exhibit executive function difficulties. 76
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Executive Functions and Clinical Diagnoses “Deficits in PFC [prefrontal cortex, aka frontal lobes] function are evident in every neuropsychiatric disorder (indeed, the term “psychiatric problem” seems synonymous with PFC dysfunction).” Arnsten & Robbins 2002 in Principles of Frontal Lobe Function
Executive Functions and Clinical Diagnoses § Most of the clinical conditions described in the DSM-V reflect some form of Executive Dysfunction § The DSM-V can be thought of as “A User’s Guide to All the Things That Can Go Wrong With the Frontal Lobes”
Executive Functions and Clinical Diagnoses § A sampling of conditions involving EF deficits: § Autism Asperger’s Syndrome § ADHD and ADD § Conduct Disorder § Oppositional Defiant Disorder § Depression and/or Anxiety § Obsessive-Compulsive Disorder § Fetal Alcohol Syndrome
Key Concept Executive Function Deficits
ADHD
All individuals with ADHD exhibit EF deficits but not all individuals that exhibit EF deficits are ADHD. 80
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Executive Functions and ADHD?
Executive Functions and ADHD
All individuals with ADHD have executive functions deficits… Executive Function Deficits
ADHD …but not all individuals with executive functions deficits have ADHD. 81
Different Constellations Perceive
Energize
Shift
Monitor
Initiate
Flexible
Correct
Interrupt
Balance
Executive Functions and ADHD Est Time
Anticipate
Stop Gauge
Sense Time
Organize
Sequence
Plan
Analyze Associate
Evaluate
Generate
Decide
Hold Manipulate
Pace
Store
Execute
Retrieve
Focus
Sustain
Modulate
Inhibit
Alan Age 10
Focus
Sustain
Modulate
Inhibit
Katie Age 11
Same Core Perceive
Energize
Shift
Monitor
Initiate
Flexible
Correct
Est Time Anticipate
Stop Interrupt
Analyze Associate
Balance
Gauge
§ EF and ADHD are not synonymous terms;; rather ADHD is a condition involving EF deficits in: § Focus/Select, Sustain, Inhibit, Modulate § Nearly all persons with ADHD also have additional self-regulation difficulties;; the nature of these additional difficulties is what makes ADHD s o v ariable from one person to the next and what causes c onfusion in diagnosis.
Generate
Different Constellations
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Organize Sense Time Plan Evaluate Decide
Sequence Pace Execute
Hold Manipulate Store Retrieve
§ Pharmacological treatment of ADHD usually only addresses the problems associated with the EFs s pecific to ADHD ( Inhibit, Modulate, Focus/Select, Sustain) § Most persons with ADHD will require additional interventions to assist with the additional self-regulation difficulties that persist even when medication is being used effectively to treat the primary ADHD problems.
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Key Concept
Executive Functions and School § Although executive functions are used to guide cognitive processing involved in new learning, many new learning situations are s tructured in ways that reduce the need for s trong executive direction. § In contrast, demonstrating what has been learned usually r equires s ignificant involvement of executive c ontrol processes.
Executive Functions activation can be internally or externally driven;; EFs c an cue the use of learned strategies. 86
Internal versus External Control
Internal versus External Control
The neural circuits for executive function activation are routed differently depending on whether the activation is based on an internally driven desire or command versus an external demand.
Because internally driven production is much easier to accomplish than externally demanded production for children with “producing difficulties” their lack of production on demand often stands in stark contrast to their seemingly effortless production “when the spirit moves them.”
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Engagement of Self-Regulation
Internal versus External Control
External Demand Pathway
The on-demand deficiencies observed by others are often attributed to negative personal characteristics s uch as lack of responsibility, apathy, passive aggressive s tance, or oppositional defiance.
Executive Functions
External Demand
Internal Command
???
Nucleus Accumbens 89
Extrinsic Rewards & Punishments
Internal Command Pathway: Intrinsically Rewarding
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Engagement of Self-Regulation
Executive Functions
Teach how to self- regulate in a way that increases the desire to self-regulate
External Demand Pathway
Internal Command
???
Nucleus Accumbens 91
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Internal Command Pathway: Intrinsically Rewarding
External Demand
Extrinsic Rewards & Punishments
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Production based on External Demand:
Production based on Internal Command:
James Age 10, Rey Complex Figure Copy:
Self-initiated
Verbally Mediated
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Questions about Intelligence
Martin’s WISC Score Changes
§ Do you believe it is possible to raise a child’s FSIQ from 70 to 100 through intervention? § Can it be done in 6 months? A year? Two years?
11/2010 4/2013 70 99 FSIQ 83 105 GAI 73 95 VCI 94 117 PRI/FRI -‐-‐ -‐-‐ VSI 62 97 WMI/AWMI 68 85 PSI
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9/2015 103 108 106 112 111 94 98
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Martin’s Achievement Score Changes
Key Concept
11/2010 4/2013 9/2015 Wd Reading
71
94
98
Wd Decoding
81
97
98
Rdg Fluency
66
95
100
Rdg Comp
-‐-‐
87
82
Rdg Vocab
-‐-‐
93
112
vs
Producing difficulties are different from learning difficulties;; producing difficulties reflect poor use of executive functions.
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A General Model for Conceptualizing Learning and Producing Difficulties
Producing versus Learning
Learning Difficulties Only
Executive Function difficulties of a severe nature (especially in the Symbol System Arena) do not result in Learning Difficulties;; they result in Producing Difficulties.
Learning Difficulties And Producing Difficulties Producing Difficulties Only
vs 99
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Often NOT recognized as a Learning Disability, even when severe, unless an evaluation involving process assessment is done Recognized fairly quickly as a Learning Disability When severe, typically attributed to lack of motivation, character f laws, or behavior/personality problems 100
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Executive Functions
EF Intervention Continuum
Executive Function Difficulties
Orienting Strategies External Control Strategies Bridging Strategies Internal Control Strategies
§ Are they the result of: § Disuse through Conscious Choice § Innate Deficiency § Maturational Delay § Disuse through Nonconscious Choice
Key Concept Intervention efforts r equire a therapeutic perspective that emphasizes a G rowth Mindset over a Fixed Mindset and a patient belief in the idea that EF difficulties “won’t last forever;; but probably longer than y ou would like.”
103
McCloskey – Executive Functions
104
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Executive Functions
EF Intervention Continuum
Key Concept
Orienting Strategies External Control Strategies Bridging Strategies Internal Control Strategies
Orienting Strategies increase awareness of executive functions and expectations for their use and provide self-regulation goals for students. 106
Key Concept
Key Concept
External Control strategies enable students to perform more effectively but do not necessarily help to improve students’ capacity for self- regulated performance. 107
McCloskey – Executive Functions
Bridging strategies effect the gradual transition from external control to self-regulated internal control. 108
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Executive Functions
Bridging Strategies
Key Concept Once learned and practiced, Internal Control Strategies enable students to effectively “run their own shows.”
Encourage the engagement of executive functions through the use of reflective questioning
110
Chapter 10: Interventions for Students with Executive Skills and Executive Functions Difficulties
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McCloskey – Executive Functions
George McCloskey Caitlin Gilmartin Betti Stanco
112
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